ONLINE RESOURCES. The National Standards for Culturally and Linguistically Appropriate Services in

Transcription

1 1.9 HOURS Continuing Education ONLINE RESOURCES for Culturally and Linguistically Appropriate Services in Home Healthcare and Hospice PART 4: RESOURCES FOR EUROPEAN PATIENTS Provision of culturally and linguistically appropriate care for home care and hospice patients is a national mandate. Finding patient-education materials in languages other than English can be a challenge for clinicians in workplaces lacking affiliation with a hospital that provides multilingual resources to its patients. Many hospitals, government agencies, and foundations have made appropriate resources freely available on the Internet. However, identifying them is time consuming. This article reviews a variety of sources for access to patient-education materials in the multiple languages of Europe. The National Standards for Culturally and Linguistically Appropriate Services in Health Care, published in 2001 by the U.S. Office of Minority Health, were developed to encourage culturally and linguistically competent care for patients with limited English proficiency. The introduction declared, sensitivity, empathetic listening, and a little extra effort can often go a long way to bridge the gap between the staff of healthcare organizations and patients who bring c ultural differences to the health encounter (p. vi). Yeo et al. (2011, p. 248) observed that cultural beliefs affect health care in that one s cultural and ethnic backgrounds shape his or her views of illness and well-being. One way for home care and hospice clinicians to be sensitive to the importance of this cultural influence on their patients is to provide educational resources in the patient s native language. Knoerl et al. (2011, p. 339) noted that sensitivity to the cultural influences and context Judith S. Young, MLS This article originally appeared in Home Healthcare Nurse 2013;31(3): S38 Home Healthcare Nurse

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3 of the client is basic to the success of an educational plan. Andrews and Friesen (2011, p. 29) urged healthcare providers to find credible, accurate, current, and reliable information on cultural competence. Implementing multilingual patient-education services can be a challenge to home care and hospice clinicians in agencies without affiliation with a large medical center that provides interpreter services and bilingual materials for its patients. A wealth of information has been made available on the World Wide Web by various government agencies, hospitals, and academic medical centers. Home healthcare and hospice clinicians can freely access this material, but finding it can be time consuming. This article is the fourth part of a series developed to assist clinicians in quickly accessing these multilingual resources. It focuses on the languages of Europe. Europe is composed of 48 countries, including Gibraltar, the Holy See, the British Isles, and Iceland. There are 56 languages other than English spoken. Immigration to the United States from Europe is lower than from other parts of the world and has been steadily dropping over the past 10 years, according to the U.S. Office of Immigration Statistics (2011). The largest group of persons obtaining legal permanent resident status in the United States in the fiscal year 2011 come from the United Kingdom. The next four largest pools come from Germany, Poland, Romania, and the Ukraine with more than 5,000 persons from each country. Together they speak at least six different languages: German, Hungarian, Polish, Romanian, Russian, and Ukrainian. This article identifies resources in those six languages (Table 1) and some of the other languages spoken in Europe. Resources for information on many of the European cultural groups are also noted. Cultural Profiles resources_16.pdf England s Multi-Faith Group for Healthcare Chaplaincy published a guide, Respecting Religious and Cultural Beliefs, in 2005, which is available for download. Among the many religious and ethnic groups included in this excellent resource those of Romany origin, also called Travellers. The information is brief, but it provides useful information on patient modesty and death and dying. culturalresources.htm The Migrant Information Centre of Eastern Melbourne (Australia) offers a series of cultural profiles on its Web site. European groups profiled include Croatian, Dutch, German, Greek, Hungarian, Italian, Macedonian, and Polish. Although the profiles include several pages of demographic information related to the groups presence in Australia, they also review attitudes toward aging, disability, and mental illness; customs and values; communication styles (including some basic words of greeting); and health beliefs and practices. Further down on the list of cultural resources is a link to a Dementia and Culture information sheet. This is a four-page list of ideas for communication, celebrations, food, activities, and care planning with Alzheimer s patients and their families from culturally and linguistically diverse backgrounds. Examples for implementing the ideas are given for several European cultures. documents/ethnicprofiles.pdf Ethnic Community Profiles, originally developed by the New Hampshire Governor s Office of Energy and Community Services, is available for download through the New Hampshire Department of Health and Human Services. The 16 ethnic groups presented here include Bosnian, Roma, and Kosovar. The profiles provide background information on the historical and cultural factors impacting the groups refugee status and review their medical practices and needs. guides/europe/index.htm Bosnia and Croatia are included in the Boston Healing Landscape Projects country profiles. This Boston University School of Medicine Web site provides a country overview and cultural background, reviews immigrant experience, and addresses healthcare issues for each cultural group. CultureClues.htm Culture Clues, developed by the University of Washington Medical Center, provide brief information aimed at increasing awareness about the patient preferences of people from diverse cultures, S40 Home Healthcare Nurse

4 Table 1. Web Sites for Online Patient Education Resources in German, Hungarian, Polish, Romanian, Russian, and Ukrainian Web site German Hungarian Polish Romanian Russian Ukranian Alzheimer Society Toronto Alzheimer s Australia Arthritis Care beyondblue Bladderbowel Cancer Council Victoria Cancer Index Diabetes UK Diversity Health Institute Clearinghouse Eastern Health Eurasia Health Health Information in Your Language Health Information Translations Health Translations Health Translations Directory Healthy Roads Media Massachusetts General Hospital MedlinePlus Multicultural Health Communication Service Palliative Care Australia Parkinson s Victoria Refugee Health Information Network Royal College of Psychiatrists Royal District Nursing Service Royal Women s Hospital Stanford Health Library Vermont Department of Health vol. 32 no. 5S May 2014 Home Healthcare Nurse S41

5 One way for home care and hospice clinicians to be sensitive to the importance of this cultural influence on their patients is to provide educational resources in the patient s native language. including Russia. A general tip sheet addresses how these cultures address illness, how medical decisions are made, and attitudes about touch and body issues. There is also a flyer available that addresses end-of-life care in Russian culture. userimages/cultural%20&%20spiritual%20 Dictionary% pdf A Dictionary of Patients Spiritual & Cultural Values for Health Care Professionals, developed by the Health Care Chaplaincy in New York, includes profiles of Gypsy/Roma culture and Russian- American culture. The coverage addresses cultural and family structure; health, illness, and death beliefs; pregnancy, birth, and postpartum; and religious and spiritual practices. Sources for Multilingual Patient- Education Materials languages/languages.html One of the most comprehensive portals for links to multilingual patient-education materials is the U.S. National Library of Medicine s (NLM) MedlinePlus. From its Health Information in Multiple Languages page, one can link to lists of resources available in Bosnian, Croatian, French, German, Italian, Polish, Portuguese, Romanian, Russian, and Ukranian. In addition, there is a mirror MedlinePlus site available in Spanish. The information available varies from language to language. For example, the list of resources in Russian is quite extensive, whereas the only Croatian resource is a fact sheet on Haemophilus influenzae Type B vaccine. Resources in German, Italian, Polish, and Romanian are not as extensive as those in Bosnian, French, and Ukrainian. Each language list is arranged alphabetically by topic. Topics can range from acute bronchitis to x-rays. Each entry provides the title in both English and the language of choice and identifies the source of the information. The entry also indicates if the resource is bilingual. If it is not, a link is provided to the English language version as well as to the language of choice version. Refugee Health Information Network provides multilingual health information for refugees and their healthcare providers. Supported by NLM, material is available in Albanian, Armenian, Bosnian, Croatian, French, German, Greek, Polish, Portuguese, Romanian, Russian, Serbo-Croatian, Spanish, and Ukrainian. Be sure to use the Find Resources tab on the left side of the page, because it leads you to a list of all languages. The colorful box on the right identifies only the most popular languages. The number of resources available and topics covered varies significantly from language to language. For example, there are only five items in Albanian, four of which address various types of vaccinations. Topics in the languages with more items include nutrition, cancer, diabetes, osteoporosis, and hypertension. Healthy Roads Media is another valuable portal supported by the NLM. The site provides links to quality information in over 20 languages and multiple formats. European languages include Bosnian, French, Russian, and Spanish. Topics available vary from language to language. For example, diabetes information is available in Bosnian, Spanish, and Russian, but not French. There are 10 resources on mental health topics available in Russian and Spanish, but only 2 in Bosnian and none in French. English versions of the material are available as well. patients Eurasia Health, which is supported by the American International Health Alliance and the U.S. Agency for International Development, provides patient resources in 23 Eastern European languages including Bosnian, Hungarian, Polish, Romanian, Russian, and Ukrainian. Searching by area of focus or keyword can be frustrating. It is easier to select a language and pull all publications available in that language. The amount of information varies from language to language. A S42 Home Healthcare Nurse

6 search for Ukrainian materials identified more than 80 documents on useful topics such as dehydration, nutrition, well-baby checkups, cast care, and constipation. rh_fact.aspx The Vermont Department of Health has fact sheets in French, Russian, and Serbo-Croatian/ Bosnian as part of its Refugee Health Program. English language versions are also available. Topics covered include nutrition, exercise, heart disease, various cancers, and a selection of infectious diseases. publications/factsheets.htm The Australian government supports a number of online sources of multilingual patient- education resources. Bladderbowel is particularly useful for home healthcare clinicians. Its fact sheets are available in Croatian, Dutch, German, Greek, Hungarian, Italian, Macedonian, Maltese, Polish, and Spanish. Topics covered include pelvic floor muscle training, bladder and bowel control in dementia, nocturia, bladder training, and prolapse. A separate English language version is available for each topic. resources_other Australia s Victorian Continence Resource Centre also has a bilingual publication available to download on continence issues. Healthy Bladder and Bowel Habits is available in Croatian, Greek, Italian, and Macedonian. MultilingualFactSheets Victoria s Royal Women s Hospital has a series of multilingual fact sheets relating to women s health. Blood clot risk reduction, although geared toward pregnancy, would be useful for home care and hospice clinicians. It is available in Greek, Italian, Macedonian, Polish, Russian, Serbian, and Spanish. The site also has continence information in Greek and Italian. bhcv2/bhcht.nsf/languagedoc/ PresentLanguage?open The Australian state of Victoria s government maintains the Health Translations Directory, which serves as a portal to well over 10,000 resources from government agencies, hospitals, and disease-focused organizations. The user has the option to search by language or topic. The languages include 23 from Europe. The number of resources available ranges from 1 in Slovak to 735 in Spanish. There are more than 500 items in Croatian, Greek, Italian, Macedonian, and Serbian. Topics covered range through the alphabet from aged care to women s health. Safety, nutrition, palliative care, dementia, diabetes, and cancer are the areas of coverage most useful for home care and hospice clinicians. The list of the languages in which a resource is available provides an indication of whether there is an English language version for many of the resources identified in the Topics directory. The agency responsible for the content of each document and date of publication are also noted. The Web site is updated regularly. TranslatedInfo.htm The government of New South Wales funds the Diversity Health Institute Clearinghouse. Its Web site has a portal to translated patient-education materials from a wide variety of sources. For each language option, the items available are arranged in chronological order by publication date with the newest resources listed first. The source of the information is clearly identified, as is its format. Many of the resources are specific to Australian social services. Browsing through the titles reveals such useful topics as coping with bereavement, medicine safety, and a general self-efficacy scale. Material is available in Albanian, Armenian, Bosnian, Croatian, Czech, Dutch, French, German, Greek, Hungarian, Italian, Macedonian, Maltese, Polish, Portuguese, Romanian, Russian, Serbian, Spanish, and Ukranian. publicationsandresources/languages.asp The New South Wales government also supports the Multicultural Health Communication Service, which provides access to an array of resources on its Web site. European languages available include Albanian, Armenian, Bosnian, Croatian, Czech, Dutch, French, German, Greek, Hungarian, Italian, Macedonian, Maltese, Polish, Portuguese, Romanian, Russian, Serbian, Spanish, and Ukrainian. Both the extent of material available vol. 32 no. 5S May 2014 Home Healthcare Nurse S43

7 and the subject coverage varies significantly from language to language. For example, there is only 1 resource in Romanian, which is about childhood tooth decay, whereas there are more than 125 in Russian. The initial title link under the language of choice takes you to an alphabetical list of all resources the service has. An annotation provides a brief description and the date the material was last revised. This is followed by a list of all the languages available for that title and a link to the PDF file for each. Topics available that are particularly appropriate for home care clinicians include aging, arthritis, explanations for various diagnostic tests, cataracts and other eye conditions, diabetes, heart disease, medication management, palliative care, and snoring. cuecards/cards.aspx Eastern Health in Australia offers a selection of cue cards in a variety of European languages. The cards have 11 categories, including medical, objects, pain level scale, and descriptions, which can be printed separately or as a complete set. The languages available are Armenian, Bosnian, Croatian, Czech, Finnish, French, German, Greek, Italian, Macedonian, Maltese, Polish, Portuguese, Romanian, Russian, Serbian, Slovak, Spanish, and Ukrainian. public/language.asp The government of Queensland, Australia, provides Health Information in Your Language on its Web site. Much of the content is links to publications on Web sites reviewed elsewhere in this article. However, there are two areas of coverage that appear to be unique to this site: There are several resources on osteoporosis in Greek and links to heart disease information in Greek, Italian, Macedonian, Polish, Portuguese, Russian, and Serbian. RESOURCES/PUBLICATIONS/Pages/ Translations.aspx Australia s Royal District Nursing Service has made a selection of translated pamphlets available on its Web site. Of particular use to home care nurses is its flier with workplace words and phrases to help the healthcare provider greet the patient, make appointments, discuss medical problems, and bid farewell. The guide includes a short introduction to the language s alphabet and provides the closest English pronunciation. This resource is available in Croatian, Dutch, German, Greek, Hungarian, Italian, Macedonian, Maltese, Polish, Russian, Serbian, and Spanish. Royal District Nursing Service also has resources on stoma care and diabetes in Greek, Italian, and Macedonian. Five healthcare organizations located in Ohio cooperated to produce Health Information Translations. The resources are easy to read, culturally and linguistically appropriate, and may be freely used by healthcare providers for patient education. European languages available include Bosnian, French, Portuguese, Russian, Spanish, and Ukrainian. Users can search by language or by topic. Topics are grouped as diagnostic tests, disaster preparedness, diseases and conditions, exercise and rehabilitation, food and diet, general information, health and wellness, home care, pain and comfort, pediatrics, pregnancy and baby care, safety, stress and coping, and surgeries and treatments. Subjects covered under the home care topic include cast care, drawing up insulin, catheter care, and postsurgical instructions. The number of items available varies from language to language. For example, How to Use an Insulin Pen is not available in Bosnian or Portuguese and Home Care After Total Joint Replacement is not available in Ukrainian. The pamphlets vary in length, and many are bilingual with illustrations. languages/default.aspx The Missouri Hospital Association maintains a Web site called Health Translations. It is a portal to resources developed by the organization itself as well as a variety of organizations such as the American Heart Association and the American Diabetes Association. The amount of information identified varies depending on the language. There are large numbers of items available in Bosnian, Russian, and Spanish, including an extensive list of publications on diabetes and heart disease. Of particular interest for home healthcare providers is the Medicare guide available in these three languages. However, for most languages, such as Ukrainian and Dutch, the only resource available is a language identification flashcard. One can do a general search by article using the Document Search function or search by broader topic. S44 Home Healthcare Nurse

8 Retrieval identifies the links to resources in alphabetical order by title of the publication, which means that users need to scroll through the entire list to find everything on their topic of interest. pointtalk.asp Massachusetts General Hospital offers Point-to- Talk Booklets on its Web site. The booklets are three pages of useful terms related to discomforts and requests. Although they were developed for use with inpatients, there are terms of value for the home care setting as well, such as I am... followed by options for lonely, sad, frightened, and similar words. These booklets are available in Albanian, French, German, Greek, Italian, Polish, Portuguese, Russian, Serbo- Croatian, and Spanish. foreign/ Stanford (University) Health Library has a page with links to resources in an extensive number of European languages. However, the site must be used with care, because there are many links that do not work. There are also links to sites in the country of origin that are not bilingual, for example, the Alzheimer s societies in Croatia, Denmark, and the Netherlands. These resources, however, could be of use for a patient who speaks that language and is computer literate or has a bilingual family member who has computer access. Many of the links are to portals of information reviewed elsewhere in this article. The most useful section is the French portal, which has links to bilingual material on an extensive number of conditions including arthritis, mental health, and pulmonary disorders. nonengresources.htm Alzheimer Society Toronto (Canada) provides links to non-english online resources on its Web site. European languages available there include Croatian, Czech, Danish, Dutch, Finnish, French, German, Greek, Hungarian, Icelandic, Italian, Macedonian, Maltese, Norwegian, Polish, Portuguese, Romanian, Russian, Spanish, Swedish, Ukranian, and Welsh. For some languages, the link is solely to the Alzheimer Society in that country. For others, there is a list of resources available by categories, such as Understanding Dementia and Caring for Persons with Dementia. understanding-dementia/information-in-other languages.aspx Alzheimer s Australia has a series of help sheets that describe dementia and how it is diagnosed and address how to plan care for a loved one with the diagnosis. Behavioral and communication issues are also addressed. The publications are available in Armenian, Croatian, Dutch, Finnish, German, Greek, Hungarian, Italian, Latvian, Macedonian, Maltese, Polish, Portuguese, Romanian, Russian, Serbian, Spanish, and Ukrainian. Australia s beyondblue provides access to mental health publications in Bosnian, Croatian, Greek, Italian, Macedonian, Polish, Russian, Serbian, and Spanish. Brochures on depression are available in all languages and material on anxiety is available in most of the languages. The publications are not bilingual, but English language versions are also available for the ones about depression. mentalhealthinfoforall/translations.aspx A selection of mental health resources in multiple languages is also available on the Royal College of Psychiatrists (United Kingdom) Web site. The topics vary from language to language, but include depression, Alzheimer s disease, medications, and cognitive behavioral therapy. The most extensive selections are in French, Lithuanian, Polish, and Spanish. Only one topic is available in German (depression), Greek (postnatal depression), Italian (bipolar disorder), and Romanian (dementia) and four topics (alcohol, depression, schizophrenia, sleep problems, and obsessivecompulsive disorder) are available in Russian. PublicationsandResources/Languages/Polish The UK Arthritis Care organization provides information in Polish. It offers both an audio file and a three-page leaflet. The leaflet is not bilingual, but the link to an English language translation is available on a different page of the Web site. Diabetes UK has resources in Albanian, Croatian, French, Italian, Polish, Portuguese, Romanian, Serbian, and Welsh. Topics covered include vol. 32 no. 5S May 2014 Home Healthcare Nurse S45

9 nutrition and diet management, cardiovascular disease, kidney disease, neuropathy, and vision. The pamphlets are not bilingual, but there are English language versions so home healthcare clinicians can read or printout the content. A selection of multilingual resources about cancer is available from Cancer Council Victoria (Australia). Topics covered include diagnosing cancer, nutrition during treatment, bowel, cancer, prostate cancer, and Pap tests. Languages available include Bosnian, Croatian, Greek, Italian, Macedonian, Maltese, Polish, Russian, Serbian, and Spanish. Cancer Index provides links to cancer organizations and treatment centers in European countries. Each link is annotated with a note about the source, the kind of resources available, and the languages involved. There is bilingual material from Austria, the Czech Republic, Denmark, Finland, France, Germany, Greece, Italy, the Netherlands, Norway, Slovenia, Spain, and Sweden. Palliative Care Australia has two brochures of use to home healthcare clinicians in need of multilingual publications: What is Palliative Care? and Facts About Morphine. They are available in Croatian, French, Greek, Italian, Macedonian, Maltese, Polish, Portuguese, Russian, Serbian, and Spanish. English language versions can be found under the Resources link on the left hand side of the page. An introductory brochure and four fact sheets on Parkinson s disease are available for download on the Parkinson s Victoria Web site. One can print from a.pdf file or listen to an audio file in Croatian, Greek, Italian, Macedonian, Russian, or Spanish. English language versions are also available. Conclusion As diversity of patient populations in all phases of healthcare continues to grow, cultural and lin- guistic competence will continue to be critical elements of effective home health agencies and essential attributes of their administrators and staff (Narayan, 2010, p. 246). Achieving and maintaining this competence can be facilitated by use of the many free, high-quality multilingual resources available for hospice and home care clinicians on the World Wide Web. Judith S. Young, MLS, is the Librarian at the Dixon School of Nursing, Abington Memorial Hospital, Willow Grove, Pennsylvania. The author and planners have disclosed that they have no financial relationships related to this article. Address for correspondence: Judith S. Young, MLS, Dixon School of Nursing, Abington Memorial Hospital, 2500 Maryland Rd., Willow Grove, PA (jyoung@amh.org). DOI: /NHH REFERENCES Andrews, M., & Friesen, L. (2011). Finding electronically available information on cultural competence in health care. Online Journal of Cultural Competence, 1(4), Retrieved from Knoerl, A. M., Esper, K. W., & Hasenau, S. M. (2011). Cultural sensitivity in patient health education. Nursing Clinics of North America, 46(3), Narayan, M. C. (2010). Culturally and linguistically appropriate services. In M. D. Harris (Ed.). Handbook of home health care administration (5th ed., pp ). Sudbury, MA: Jones and Bartlett. Office of Immigration Statistics. (2011). Yearbook of immigration statistics. Retrieved from Office of Minority Health. (2001). National standards for culturally and linguistically appropriate services in health care: Executive summary. Retrieved from executive.pdf. Yeo, T. P., Phillips, J., Delengowski, A., Griffiths, M., & Purnell, L. (2011). Oncology nursing: Educating advanced practice nurses to provide culturally competent care. Journal of Professional Nursing, 27(4), Readers who wish to participate in a CE exercise associated with this article may do so by clicking on the following link: S46 Home Healthcare Nurse